Boston Business Journal: Where Massachusetts ranks when it comes to Medicare waste

Where Massachusetts ranks when it comes to Medicare waste

Jan 27, 2017, 6:00am EST

The good news is that improper Medicare payments to health care providers fell sharply in 2015. The bad news: The overbilling still totaled in the hundreds-of-millions of dollars nationwide.

According to the Centers for Medicare and Medicaid, overpayments totaled $350.6 million in 2015, the latest reporting year available. That figure was down approximately 85 percent from 2014’s total of $2.3 billion — an all-time high according to the Council for Medicare Integrity, a nonprofit health care research and policy concern based in Washington, D.C.

The overpayments are based on data reported through the federal government’s Recovery Audit Contractor Program established last decade to identify improper billings — and to potentially recover funds — allocated through the Medicare part A and B programs.

On a per-patient basis, Washington, D.C., topped the rankings with an average overpayment of $30.90 per eligible Medicare beneficiary. With a Medicare population of roughly 79,000 people, the nation’s capital had the fewest beneficiaries among the states analyzed. It was the second year in a row that D.C. topped the Council for Medicare Integrity’s rankings as the state with the highest overpayments per beneficiary.

Massachusetts came in toward the bottom of the list, at number 35, with an average overpayment of $3.43 per eligible Medicare beneficiary. Among New England states, that average put the Bay State second only to Connecticut.

California, the state with the most Medicare beneficiaries as of 2015, averaged overpayments of $14.72 per beneficiary, ranking it 43rd nationally. California also held the distinction as the state that saw the steepest year-over-year decline, to $47.8 million in 2015 from $261 million in 2014, in overpayments estimated by the federal government.

Nationally, the dramatic year-over-year decline in Medicare overpayments appears to stem from greater enforcement of RAC programs, which were weakened in 2013 after intense lobbying by the health care sector.